Global Variations in Heart Failure Etiology, Management, and Outcomes
Authors: Mariela Rasmussen, Aldo Prado, Miguel A. Hominal, Cesar J. Zaidman, Guillermo Cursack, Ignacio MacKinnon, Gerardo Zapata, David G. Rojas, Ruben G. Duran, Oscar G. Vilamajo, Oscar P. Dutra, Lívia Oliveira, Ricardo Pavanello, César Minelli, Antonio Sousa, Lilia N. Maia, Mauro E. Hernandes, Múcio Oliveira, Weimar K. S. B. De Souza, Fernando Nobre, Nadine Clausell, Eduardo Abib, Silmeia Z. Bazan, Gilmar Reis, Nkoke Clovis, Cabral Tantchou, Joseph P. Abah, Charles K. Kouam, Anastase D. Tamdja, Guillaume E. Manon, Serah M. Abang, Stachys A. N. Feuzeu, Herve M. Ban'Haka, Chris N. Nganou-Gnindjio, Sih Colette, Albert Nyanga, Tchinda G. Fomekong, Jules Ndjebet, Florent A. D. Ngongang, Kim Anderson, Serge Lepage, Francois Tournoux, Normand Racine, Stuart Smith, Robert McKelvie, Gordon Moe, Shelley Zieroth, Mustafa Toma, Ying T. Sia, George Heckman, Heather Ross, Justin Ezekowitz, Mario Senechal, Elizabeth Swiggum, Mario Vega, Gabriel Jano, Braulio Bobadilla, Huiqiong Tan, Jian W. Gou, Wei Jin, Heng Jiang, Fen Ai, Wenxiu Zhou, Hai Y. Luo, Fang Wei, Zhisheng Jia, Jie Peng, Xiuhong Wang, Xioajuan Bai, Jing Xu, Xue W. Liang, XiaoPing Chen, Tianxun Wang, Tinlin Zheng, Shaoming Qin, Tao Liang, Gange Tan, Xia Gao, Yunguo Chen, Jijin Wu, Angel Garcia, Nelson Murillo, Juan A. Ceron, Dora I. M. De Salazar, Jorge Sandoval, Andres Buitrago, Julian E. V. Eljach, Jose L. A. Mendoza, Gustavo S. Moreno, Henry G. Lozada, Erika M. M. Carreno, Franklin Quiroz, Alberto Cadena Bonfanti, Jannes Buelvas, Fredy A. T. Dada, Peter Sogaard, Maria Pedersen, Gunnar Gislason, Gitte Nielsen, Henrik Wiggers, Milton S. Jaramillo, Nicholas Anzules, Yan C. Duarte, Freddy P. C. Long, Iván Zuelta, Mayra S. Velez, José Lopez, Freddy Trujillo, Santiago Carrasco, Sadi Gulec, Yuksel Cavusoglu, Deniz R. Acar, Mehmet B. Yilmaz, Ahmet Celik, Philippe Gosse, David Kenizou, Nicolas Delarche, Romain Boulestreav, Samuel Goussot, Kamel H. Hamou, Francois Jourda, Jean Paul Guillot, Jean Michel Tartiere, Sebastian Schellong, Heiko Mahrholdt, Wolfgang Jungmair, Christoph Kadel, Alexander Wolf, Oliver Bruder, Michael C Bott, Herbert Nagele, Klaus Hertting, Wulf Ito, Rene Hintze, Fabian Stahl, Sebastian Maier, Christian Weiss, Thomas Stoerk, Michael Drexler, Andreas Hagenow, Sanjeev Asotra, Gaurav Chaudley, Rajeev Gupta, Bishav Mohan, Narendra Jathappa, Kiron Varghese, Jabir Abdullakutty, Parkash Negi, Sunil Karna, Sharad Chandra, Giulia Russo, Franco Cosmi, Simona D'Orazio, Michele Gulizia, Tiziano Moccetti, Francesca Scopigni, Claudio Marcassa, Anna Frisinghelli, Giovanni Q Villani, Flavio Venturi, Giancarlo Piccinni, Massimo Piepoli, Wafula Nalwa, Evelyn Mbugua, Felix Barasa, Eliodoro Castro-Montes, Jose A. C. Lopez, Yadav Bhatta, Deewakar Sharma, Victor Ansa, Okechukwu Ogah, Hadiza Saidu, Azhar M. Kayani, Lauren K. Evangelista, Louie Tirador, Josefina Cruz, Dante Morales, Dennis Sulit, Janusz Bednarski, Tomasz Czerski, Marcin Skorski, Krzysztof Cymerman, Marek Korol, Beata Miklaszewicz, Marek Piepiorka, Marek Wujkowski, Ewa Mirek-Bryniarska, Michal Owsiak, Jacek Gniot, Arkadiusz Stasiwski, Monika Solkiewicz, Wanda Sudnik, Arkadiusz Chmielinski, Aurora Andrade, Ilidio Moreira, Svetlana Isakova, Shvedov Ivan, Natalia Kovalkova, Dmitry Panov, Anzhela Salbieva, Zabashta Sergey, Yulia Yufereva, Anara Yusubova, Tatiana Poponina, Valery Gafarov, Irina Osipova, Yury Pozdnyakov, Zhanna Sizova, Waleed Habeeb, Yasser Kassim, Salwa Monem, Mohamed Zeyad, Sami Alasmari, Kamal Alghalayini, Abdulhalim Kinsara, Ubaid Ullah Jan, Samih Lawand, Makgotsane J. Mphahlele, Khulile Moeketsi, Mpiko Ntsekhe, Andrew Ratsela, Baby M. Thomas, Eduardo B. Caballero, Rafael De La Espriella, Iris Garrido Bravo, Gema Minan, Maria J. Paniagua Martin, Francisco Perez, Josep L. Roses, Evelyn Santiago, Valentina Goloskokova, Jorgen Thulin, Tonje Thorvaldsen, Carl-Johan Lindholm, Nagy Z Floderer, Ingemar Lönnberg, Said Kanenda, Neema Duma, John R. Meda, Pilly Chillo, Rainer Vogt, Fredrick Kalokola, Johannes Kataraihya, Benson Mwakalukwa, Peter Kisenge, Hande E. O. Cetin, Charles Lugero, Leonid Voronkov, Sergiy Fedorov, Svitlana Andriyevska, Larysa Vereschuk, Yulia Zalizna, Pardeep Jhund, John Barton, Andrew Moriarty, Patrick Donnelly, Andrew Murphy, Tim Edwards, Christopher Arden, Ahmet Fuat, Fraser Witherow, Brendan Mcadam, Raluca Arimie, Frederic Adler, Kristen Maurice, Mark A. Meier, Rajendra Mehta, Timothy Kitchen, Vinay Malhotra, David Whellan, Illeana Piña, Sandhya Murthy, John Kostis, Martha Gulati, Radha Gopalan, Hanna Gaggin, Sophia Airhart, Elizabeth Juneman, Nancy Sweitzer, Stephen Thew, Philip Joseph, Ambuj Roy, Eva Lonn, Stefan Störk, John Floras, Lisa Mielniczuk, Jean-Lucien Rouleau, Jun Zhu, Anastase Dzudie, Kumar Balasubramanian, Kamilu Karaye, Khalid F. AlHabib, Juan Esteban Gómez-Mesa, Kelley R. Branch, Abel Makubi, Andrzej Budaj, Alvaro Avezum, Thomas Wittlinger, Georg Ertl, Charles Mondo, Nana Pogosova, Aldo Pietro Maggioni, Andres Orlandini, Alexander Parkhomenko, Ahmed ElSayed, Patricio López-Jaramillo, Alex Grinvalds, Ahmet Temizhan, Camilla Hage, Lars H. Lund, Khawar Kazmi, Fernando Lanas, Sanjib Kumar Sharma, Keith Fox, John J.V. McMurray, Darryl Leong, Hisham Dokainish, Aditya Khetan, Gerald Yonga, Kristian Kragholm, Kerolos Wagdy Shaker, Julius Chacha Mwita, Arif Abdullatif Al-Mulla, François Alla, Albertino Damasceno, José Silva-Cardoso, Antonio L. Dans, Karen Sliwa, Martin O’Donnell, Nooshin Bazargani, Antoni Bayés-Genís, Tara McCready, Jeffrey Probstfield, Salim Yusuf
Journal: JAMA (2023)

Importance Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. Objective To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Design, Setting, and Participants Multinational HF registry of 23 341 participants in 40 high-income, upper–middle-income, lower–middle-income, and low-income countries, followed up for a median period of 2.0 years. Main Outcomes and Measures HF cause, HF medication use, hospitalization, and death. Results Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper–middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower–middle-income countries (39.5%) ( P &amp;amp;lt; .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper–middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower–middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper–middle-income countries (ratio = 2.4), similar in lower–middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper–middle-income countries (9.7%), then lower–middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower–middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. Conclusions and Relevance This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally.